Making informed decisions about your end-of-life medical care requires understanding what the treatments actually involve. Many people complete advance directives using phrases like "no heroic measures" — but what does that mean in practice? This guide explains the most common life-sustaining medical treatments in plain language.
Cardiopulmonary Resuscitation (CPR)
CPR is performed when a person's heart stops beating (cardiac arrest) or they stop breathing. It includes:
- Chest compressions to manually pump blood
- Mouth-to-mouth or bag-mask ventilation to provide oxygen
- Defibrillation (electric shock) to restart the heart
- Medications to support heart function
CPR can be life-saving in otherwise healthy people who experience sudden cardiac arrest. For people with serious illness, advanced age, or multiple organ failure, the survival rate is significantly lower — and survivors often face additional medical complications. A DNR order instructs providers not to perform CPR.
Mechanical Ventilation
A ventilator is a machine that breathes for a patient who cannot breathe adequately on their own. A breathing tube is inserted into the throat and connected to the machine. Mechanical ventilation is used short-term in emergency situations and long-term for patients who cannot breathe independently.
Important considerations:
- Being on a ventilator requires sedation to prevent discomfort
- It prevents normal speech and eating
- Removing a ventilator from a patient who cannot breathe without it will lead to death — this decision may be required even if a ventilator was started in an emergency
Artificial Nutrition and Hydration (Feeding Tubes)
When a patient cannot eat or drink, nutrition and fluids can be provided through:
- Nasogastric tube: A tube inserted through the nose into the stomach (short-term)
- PEG tube (percutaneous endoscopic gastrostomy): A tube surgically placed directly into the stomach (longer-term)
- Intravenous (IV) fluids: Hydration provided through a vein
Artificial nutrition can sustain life indefinitely in some cases — including in patients who are otherwise in a persistent vegetative state. For patients who are actively dying, research suggests that artificial nutrition and hydration often doesn't improve comfort and may increase it in some situations.
Dialysis
Dialysis artificially performs the kidney's function of filtering waste from the blood when the kidneys fail. It requires regular (often three times weekly) sessions, each lasting several hours. Dialysis can maintain life for patients with end-stage kidney disease, but it is burdensome — affecting quality of life significantly. Discontinuing dialysis for patients with end-stage renal disease will lead to death within days to weeks.
Antibiotics and Aggressive Treatment of Infection
For patients at end of life who develop infections, aggressive antibiotic treatment may extend life — or may cause side effects (including secondary infections) that reduce comfort without significantly extending meaningful life. This is an area where patient values vary, and where a conversation with your physician is particularly valuable.
Comfort Care (Palliative Approach)
When the goal shifts from cure or life extension to comfort, the focus becomes managing pain, anxiety, breathlessness, and other symptoms. Comfort care (also called palliative care) can be provided alongside curative treatment or as the primary approach. Hospice care is a comprehensive form of comfort-focused care for people near the end of life.
Documenting Your Preferences
Understanding these treatments is essential for completing an advance directive that truly reflects your wishes. Vague language ("I don't want to be kept alive artificially") is less useful than specific instructions ("I do not want mechanical ventilation if my condition is terminal and irreversible"). The more specific your directive, the more useful it is when decisions need to be made.